753 research outputs found
The use of Performance Measurement as an Accountability Mechanism: a case study in the UK National Health Service
The UK Labour government has recently developed the NHS Plan, which specifies long-term objectives and strategies for the development of the National Health Service. Along with the NHS Plan has come the development of Service and Financial Frameworks (SaFFs). The aim of SaFFs is to overcome the potential agency problem that exists between government and NHS organizations (Heymann, 1988) by enhancing the accountability of local NHS organizations for delivering the outcomes required by the NHS Plan.
This study uses a case study to explore how the SaFF has been applied as a new NHS performance measurement tool and identifies issues affecting the usefulness of the SaFF as an accountability mechanism. The findings illustrate how the introduction of SaFFs has allowed the government to introduce additional non-financial/process performance indicators and tougher performance monitoring processes.
This study also identifies issues related to the choice, relevance and informational quality of performance indicators. The findings suggest that, given the shortcomings in the SaFF’s performance measurement contributions, a key early aim of this new accountability mechanism may be to serve central government’s need to deliver a political message to the public. If the SaFF is to develop into an effective accountability mechanism and support the key aims of the NHS Plan, careful selection of performance indicators and adequate information systems will be crucial
Developing site-specific guidelines for orchard soils based on bioaccessibility – Can it be done?
Horticultural land within the periurban fringe of NZ towns and cities increasingly is being developed for residential subdivision. Recent surveys have shown that concentrations of As, Cd, Cu, Pb, and ΣDDT (sum of DDT and its degradation products DDE and DDD) in such soils can exceed criteria protective of human health.¹ Soil ingestion is a key exposure pathway for non-volatile contaminants in soil. Currently in NZ, site-specific risk assessments and the derivation of soil guidelines protective of human health assume that all of the contaminant present in the soil is available for uptake and absorption by the human gastrointestinal tract. This assumption can overestimate health risks and has implications for the remediation of contaminated sites.² In comparison, the bioavailability of contaminants is considered when estimating exposure via dermal absorption and by ingestion of home-grown produce.³ Dermal absorption factors and plant uptake factors are included in the calculations for estimating exposures via these routes
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Psychometric properties of the Stroke and Aphasia Quality of Life Scale (SAQOL-39) in a generic stroke population
Background: We previously developed the Stroke and Aphasia Quality of Life scale (SAQOL-39) and tested it with people with chronic aphasia. A scale allowing comparisons of quality of life between people with versus without aphasia post-stroke would be of value to clinicians.
Objectives: To evaluate the psychometrics of the SAQOL-39 in a generic stroke sample. Should this process result in a generic-stroke version of the scale (SAQOL-39g), a further aim is to compare the latter and the SAQOL-39 as tested in chronic aphasia.
Design and subjects: Repeated measures psychometric study, evaluating internal consistency, test—retest reliability, construct validity and responsiveness to change. People admitted to hospital with a first stroke were assessed two weeks, three months and six months post stroke.
Measures: SAQOL-39, National Institutes of Health Stroke Scale, Barthel, Frenchay Aphasia Screening Test, General Health Questionnaire-12 and Frenchay Activities Index.
Results: Of 126 eligible participants, 96 (76%) participated and 87 (69%) were able to self-report and are presented here. Testing the SAQOL-39 in generic stroke resulted in the SAQOL-39g, which has the same items as the SAQOL-39 but three domains: physical, psychosocial, communication. The SAQOL-39g showed good internal consistency (α = 0.95 overall score, 0.92—0.95 domains), test—retest reliability (interclass correlation (ICC) = 0.96 overall, 0.92—0.98 domains), convergent (r = 0.36—0.70 overall, 0.47—0.78 domains) and discriminant validity (r = 0.26 overall, 0.03—0.40 domains). It differentiated people by stroke severity and visual analogue scale (VAS)-defined quality of life. Moderate changes (d = 0.35—0.49; standardized response mean (SRM) = 0.29—0.53) from two weeks to six months supported responsiveness.
Conclusions: The SAQOL-39g demonstrated good reliability, validity and responsiveness to change. It can be used to evaluate quality of life in people with and without aphasia post stroke
Rapid, reliable, and reproducible molecular sub-grouping of clinical medulloblastoma samples
The diagnosis of medulloblastoma likely encompasses several distinct entities, with recent evidence for the existence of at least four unique molecular subgroups that exhibit distinct genetic, transcriptional, demographic, and clinical features. Assignment of molecular subgroup through routine profiling of high-quality RNA on expression microarrays is likely impractical in the clinical setting. The planning and execution of medulloblastoma clinical trials that stratify by subgroup, or which are targeted to a specific subgroup requires technologies that can be economically, rapidly, reliably, and reproducibly applied to formalin-fixed paraffin embedded (FFPE) specimens. In the current study, we have developed an assay that accurately measures the expression level of 22 medulloblastoma subgroup-specific signature genes (CodeSet) using nanoString nCounter Technology. Comparison of the nanoString assay with Affymetrix expression array data on a training series of 101 medulloblastomas of known subgroup demonstrated a high concordance (Pearson correlation r = 0.86). The assay was validated on a second set of 130 non-overlapping medulloblastomas of known subgroup, correctly assigning 98% (127/130) of tumors to the appropriate subgroup. Reproducibility was demonstrated by repeating the assay in three independent laboratories in Canada, the United States, and Switzerland. Finally, the nanoString assay could confidently predict subgroup in 88% of recent FFPE cases, of which 100% had accurate subgroup assignment. We present an assay based on nanoString technology that is capable of rapidly, reliably, and reproducibly assigning clinical FFPE medulloblastoma samples to their molecular subgroup, and which is highly suited for future medulloblastoma clinical trials
Metrics to evaluate research performance in academic institutions: A critique of ERA 2010 as applied in forestry and the indirect H2 index as a possible alternative
Excellence for Research in Australia (ERA) is an attempt by the Australian
Research Council to rate Australian universities on a 5-point scale within 180
Fields of Research using metrics and peer evaluation by an evaluation
committee. Some of the bibliometric data contributing to this ranking suffer
statistical issues associated with skewed distributions. Other data are
standardised year-by-year, placing undue emphasis on the most recent
publications which may not yet have reliable citation patterns. The
bibliometric data offered to the evaluation committees is extensive, but lacks
effective syntheses such as the h-index and its variants. The indirect H2 index
is objective, can be computed automatically and efficiently, is resistant to
manipulation, and a good indicator of impact to assist the ERA evaluation
committees and to similar evaluations internationally.Comment: 19 pages, 6 figures, 7 tables, appendice
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“I’ve got somebody there, someone cares”: what support is most valued following a stroke?
Purpose: There is often a need for increased support following a stroke. This study explored what types of support are provided by different network members, and what support functions are most valued.
Methods: Adults with first stroke were recruited from a stroke unit, and participated in in-depth interviews 8-15 months post stroke. Framework Analysis was used to build thematic and explanatory accounts of the data.
Results: Twenty-nine participants took part. Main themes to emerge were: the spouse was the most important provider of support; children were a relatively stable source of support, although many participants expressed reservations about worrying a child; relatives and friends typically provided social companionship and emotional support rather than on-going practical support. The only universally valued support function was the sense that someone was concerned and cared. Other valued functions were: social companionship including everyday social ‘chit chat’; practical support provided sensitively; and, for many, sharing worries and sensitive encouragement. The manner and context in which support was provided was important: support was easiest to receive when it communicated concern, and was part of a reciprocal, caring relationship.
Conclusions: As well as measuring supportive acts, researchers and clinicians should consider the manner and context of support
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Does mode of administration affect health-related quality-of-life outcomes after stroke?
Telephone interviews and postal surveys may be a resource-efficient way of assessing health-related quality-of-life post-stroke, if they produce data equivalent to face-to-face interviews. This study explored whether telephone interviews and postal surveys of the Stroke and Aphasia Quality of Life Scale (SAQOL-39g) yielded similar results to face-to-face interviews. Participants included people with aphasia and comprised two groups: group one (n =22) were 3-6 months post-stroke; group two (n =26) were ≥1 year post-stroke. They completed either a face-to-face and a telephone interview or a face-to-face interview and a postal survey of the SAQOL-39g. Response rates were higher for group two (87%) than for group one (72-77%). There were no significant differences between respondents and non-respondents on demographics, co-morbidities, stroke severity, or communication impairment. Concordance between face-to-face and telephone administrations (.90-.98) was excellent; and very good-excellent between face-to-face and postal administrations (.84-.96), although scores in postal administrations were lower (significant for psychosocial domain and overall SAQOL-39g in group two). These findings suggest that the SAQOL-39g yields similar results in different modes of administration. Researchers and clinicians may employ alternative modes, particularly in the longer term post-stroke, in order to reduce costs or facilitate clients with access difficulties
A genetic mouse model with postnatal Nf1 and p53 loss recapitulates the histology and transcriptome of human malignant peripheral nerve sheath tumor
BACKGROUND: Malignant peripheral nerve sheath tumors (MPNST) are aggressive sarcomas. Somatic inactivation of
METHODS: We combined 2 genetically modified alleles, an
RESULTS: Postnatal
CONCLUSIONS: The NP-Plp model recapitulates human MPNST genetically, histologically, and molecularly
East Midlands Research into Ageing Network (EMRAN) Discussion Paper Series
Academic geriatric medicine in Leicester
.
There has never been a better time to consider joining us. We have recently appointed a
Professor in Geriatric Medicine, alongside Tom Robinson in stroke and Victoria Haunton,
who has just joined as a Senior Lecturer in Geriatric Medicine. We have fantastic
opportunities to support students in their academic pursuits through a well-established
intercalated BSc programme, and routes on through such as ACF posts, and a successful
track-record in delivering higher degrees leading to ACL post. We collaborate strongly
with Health Sciences, including academic primary care. See below for more detail on our
existing academic set-up.
Leicester Academy for the Study of Ageing
We are also collaborating on a grander scale, through a joint academic venture focusing
on ageing, the ‘Leicester Academy for the Study of Ageing’ (LASA), which involves the
local health service providers (acute and community), De Montfort University; University
of Leicester; Leicester City Council; Leicestershire County Council and Leicester Age UK.
Professors Jayne Brown and Simon Conroy jointly Chair LASA and have recently been
joined by two further Chairs, Professors Kay de Vries and Bertha Ochieng. Karen
Harrison Dening has also recently been appointed an Honorary Chair.
LASA aims to improve outcomes for older people and those that care for them that takes
a person-centred, whole system perspective. Our research will take a global perspective,
but will seek to maximise benefits for the people of Leicester, Leicestershire and Rutland,
including building capacity. We are undertaking applied, translational, interdisciplinary
research, focused on older people, which will deliver research outcomes that address
domains from: physical/medical; functional ability, cognitive/psychological; social or
environmental factors. LASA also seeks to support commissioners and providers alike for
advice on how to improve care for older people, whether by research, education or
service delivery. Examples of recent research projects include: ‘Local History Café’
project specifically undertaking an evaluation on loneliness and social isolation; ‘Better
Visits’ project focused on improving visiting for family members of people with dementia
resident in care homes; and a study on health issues for older LGBT people in Leicester.
Clinical Geriatric Medicine in Leicester
We have developed a service which recognises the complexity of managing frail older
people at the interface (acute care, emergency care and links with community services).
There are presently 17 consultant geriatricians supported by existing multidisciplinary
teams, including the largest complement of Advance Nurse Practitioners in the country.
Together we deliver Comprehensive Geriatric Assessment to frail older people with
urgent care needs in acute and community settings.
The acute and emergency frailty units – Leicester Royal Infirmary
This development aims at delivering Comprehensive Geriatric Assessment to frail older
people in the acute setting. Patients are screened for frailty in the Emergency
Department and then undergo a multidisciplinary assessment including a consultant
geriatrician, before being triaged to the most appropriate setting. This might include
admission to in-patient care in the acute or community setting, intermediate care
(residential or home based), or occasionally other specialist care (e.g. cardiorespiratory).
Our new emergency department is the county’s first frail friendly build and includes
fantastic facilities aimed at promoting early recovering and reducing the risk of hospital
associated harms.
There is also a daily liaison service jointly run with the psychogeriatricians (FOPAL); we
have been examining geriatric outreach to oncology and surgery as part of an NIHR
funded study.
We are home to the Acute Frailty Network, and those interested in service developments
at the national scale would be welcome to get involved.
Orthogeriatrics
There are now dedicated hip fracture wards and joint care with anaesthetists,
orthopaedic surgeons and geriatricians. There are also consultants in metabolic bone
disease that run clinics.
Community work
Community work will consist of reviewing patients in clinic who have been triaged to
return to the community setting following an acute assessment described above.
Additionally, primary care colleagues refer to outpatients for sub-acute reviews. You will
work closely with local GPs with support from consultants to deliver post-acute, subacute,
intermediate and rehabilitation care services.
Stroke Medicine
24/7 thrombolysis and TIA services. The latter is considered one of the best in the UK
and along with the high standard of vascular surgery locally means one of the best
performances regarding carotid intervention
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